I agree with Drs Koppel and Soumerai that allowing patients to view their medical records and e-mail their physicians may generate questions that lead to additional office visits. In addition, physicians may be uncomfortable trying to deal with medical issues remotely and request that patients schedule an appointment to be seen. I also agree that volunteer bias is a potential problem not only for retrospective studies such as ours, but also for all observational research studies. We attempted to control for volunteer bias in our study by having each cohort serve as their own control and by performing both intracohort and intercohort analyses. Volunteer bias is controlled within a trial by randomization, but it still may occur when patients, clinicians, or sites decide whether to participate.
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